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Get MD MCPS 525-13 2006

D by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required. Student: Birthdate: Prescription.

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